Tobacco Smoking and Illicit Drug Use in Australia

Wayne Hall, Doug Fraser,

and Coral Gartner University of Queensland Centre

for Clinical Research

Outline of Talk

• Long term smoking trends: 1945-2010 • Recent trends: 1980-2010

• Convergence in prevalence men and women • Social class trends in prevalence • Mental health and smoking

• Tobacco use among illicit drug users • Party drug users and tobacco smoking 2001-2010

• Explaining these relationships • Patterns of illicit drug involvement • Are party drugs going downmarket? • Smoking as a marker of rebellion and risk taking

• What should be done?

Smoking prevalence in Australia 1945-2010

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50

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70

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1940 1950 1960 1970 1980 1990 2000 2010

males

females

Trends in young adult smoking prevalence 1980-2010

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5

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25

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35

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45

50

1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010

18-2425-29

Daily smoking rates by birth cohort

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60

1920-29 1930-39 1940-49 1950-59 1960-69 1970-79

malesfemales

Average number of cigs per day among smokers 18-29 years, 1980-2010

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5

10

15

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25

1980 1983 1986 1989 1992 1995

18-2425-29

What policies have reduced smoking?

• Taxation increases on tobacco: • per stick since 1992

• Restrictions on smoking • Workplaces late 1980s; public places, 1990s

• Bans on advertising and promotion • Quit lines & media campaigns: Cancer councils • Most cost effective policies:

• Taxation • Advertising bans • Smoking bans in workplaces and public places

Trends in tobacco consumption and public health policies

Relationship between tobacco sales and prices. 1970-2005

Smokers’ characteristics 1997-2007 Mathews et al, 2010

• National Surveys of Mental Health and Well-Being • Household surveys in 1997 and 2007

• In both surveys smokers were more likely to: • Be socially disadvantaged • Less well educated • Report symptoms of psychological distress • Have anxiety and affective disorders • Have an alcohol or other drug use disorder

Have smokers “hardened” 1997-2007?

• Have smokers become more: • nicotine dependent • social disadvantaged • mental distressed?

• Very little evidence of hardening: • Small increase in social disadvantage

– But not for dependence or comorbid disorders • Average N cigs per day has decreased • No increase in psychological distress • No increase in prevalence of other mental disorders

Smoking and illicit drug use 2001-2010

• How are smoking and illicit drug use related?

• Have these relationships changed 2001-2010?

• Used NDS surveys for 2001 and 2010 to examine: • Prevalence of smoking in young adults • Relationship to illicit drug use • Adjusting for sociodemographic differences

Analyses

• National Drug Strategy Household Survey • 27 000 respondents across Australia • Weighted to Australian population

• Analysis of smoking rates in Surveys in: • 2001 and 2010 • Among young adults (18 – 29 years old)

• 3 categories of illicit drug user 1. Party drug users (excluding injectors) 2. Other illicit drug users (including injectors) 3. Non users

Drug use categories • ‘Party’ drug users: 10.5% of young adults

• Any ecstasy, cocaine or GHB use in the last 12 months • never injected drugs

• ‘Other’ illicit drug users: 6.5% of young adults • Any use in last 12 months of: • meth/amphetamines, inhalants, heroin, pain killers,

tranquilisers, methadone, hallucinogens, and opiates • not used party drugs in last 12 months

• Non users of illicit drugs: 83% of young adults • Not used any illicit drugs in the last 12 months • Never injected drugs

Drug user characteristics 2001 2010

Non users (%)

Party drugs (%)

Other illicits (%)

Non users (%)

Party drugs (%)

Other illicits (%)

SES

Lowest 17 9 20 18 11 25 Second 27 19 29 19 16 17 Third 20 22 18 20 17 18 Fourth 14 16 17 23 23 20 Highest 23 34 16 21 34 21

Sex

Female 51 42 47 51 42 45 Male 49 58 53 49 58 55

Education

Bachelor+ 21 24 13 26 24 18 Year 12 32 33 24 31 33 27 Cert/dip 33 31 38 31 33 36 < year 12 15 11 25 11 10 18

Sociodemographic Trends

• Majority of party drug users male

• Party drug users higher SES and more education than: • Nonusers of illicit drugs and • Users of other illicit drugs

• Patterns consistent from 2001 to 2010

Proportion of drug users who smoke daily

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Non user Party drugs Other illicits Overall

2001

2010

Demographic correlates of daily smoking

Model 1 Variable OR (95% CI) p Value

SES 0.92 (0.87-0.97) .001

Year 2001 1.00 2010 0.65 (0.56-0.75) < .001

Drug use category Non user 1.00 Party drugs 4.26 (3.45-5.26) < .001 Other Illicits 3.57 (2.79-4.57) < .001

Sex Female 1.00 Male 1.14 (0.99-1.32) .079

Highest education Bachelor or higher 1.00 Year 12 1.99 (1.55-2.55) < .001 Cert/Dip 3.41 (2.69-4.33) < .001 < year 12 5.70 (4.36-7.44) < .001

Proportion of drug users who use cannabis at least monthly

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Non user Party drugs Other illicits Overall

2001

2010

Model 2 - including cannabis Variable OR (95% CI) p Value

SES 0.93 (0.88-0.98) .007

Year 2001 1.00 2010 0.68 (0.59-0.79) < .001

Drug use category Non user 1.00 Party drugs 2.42 (1.90-3.08) < .001 Other Illicits 2.41 (1.85-3.14) < .001

Sex Female 1.00 Male 1.02 (0.88-1.18) .823

Highest education Bachelor or higher 1.00 Year 12 1.88 (1.46-2.42) < .001 Cert/Dip 3.31 (2.60-4.22) < .001 < year 12 5.26 (4.00-6.91) < .001

Cannabis use Never/infrequent 1.00 At least monthly 4.19 (3.35-5.25) < .001

Predictors of daily smoking

Explanations

• Natural history of drug involvement • Cigarettes, alcohol, cannabis and other illicit drugs

• Shared social trajectory • Smoking and party drugs both going down market?

• Smoking as a social marker of rebellion • Back to the future

Patterns of Drug Involvement

• “Gateway” sequence of involvement • Alcohol &/or tobacco precede cannabis • Cannabis use precedes pills and powders • Pills and powders precede heroin and IDU

• Predictors of progression • Early initiation of any drug • Heavier use of any drug predicts progression

• Earlier drug use patterns usually retained • Later drugs usually added to repertoire • Producing a Guttman scale of drug involvement

Patterns of Drug Involvement

• Key role for cigarette smoking • “Gateway” to cannabis use:

• Route of administration effect • Reverse gateway now seen in Australia

• Cannabis use and other illicit drug use • Heavier users more likely to use party drugs

• This pattern predicts: • Higher rates of smoking among party drug users

Are party drugs going down market?

• Cigarette smoking • Has been going down market for over 20 years • reduced uptake and higher cessation among higher SES

• What about party drugs? • First used by better educated, often during higher education

• Social trajectory of cannabis, LSD, & cocaine • avant garde college students middle class blue collar

• Little evidence of this between 2001-2010: • SES and education remained stable for party drug users

Cigarette smoking as a marker of rebellion

• In the 1890s and 1900s • Cigarettes, larrikinism & antisocial behaviour • Strongly disapproved of by male pipe smokers

• The World Wars and acceptance of smoking: • WW-I normalised RYO smoking • WW-II did the same for manufactured cigarettes

• As smoking prevalence has declined: • Renewal of smoking as mark of rebellion? • Drug used by risk takers and sensation seekers • Who are more likely to use illegal drugs

What should be done?

• Should we pay more attention to cigarette and cannabis smoking among illicit drug users?

• If so, how? – Advice on the risks of smoking? – Promotion of smoking cessation aids? – Tobacco harm reduction advice? – Cannabis harm reduction advice?

Acknowledgements

• Coral Gartner and Doug Fraser • Data analyses and help with paper

• Kate Morley • Converging smoking prevalence in males and females

• Rebecca Mathews and Coral Gartner • Tests of the hardening hypothesis

• Michelle Scollo and Margaret Winstanley • Information on smoking trends in Australia